Elissa Epel, a professor of psychiatry at UC San Francisco, studies how stress affects the body.

There’s no shortage of advice out there about what makes a healthy lifestyle. Get regular exercise. Reduce stress. Eat whole foods. It all sounds good, but the advice is easy to ignore when you are tired or anxious or craving a donut.

But what if you could envision exactly what your healthy habits—or unhealthy ones—are doing to the cells in your body? The Telomere Effect (Grand Central Publishing, 2017), a bestselling book by Dr. Elizabeth Blackburn and Dr. Elissa Epel, allows readers to do just that.

“We all know what’s good for us, but that’s not always motivating in the short term,” said Epel, a professor of psychiatry at the University of California San Francisco and a leading expert on how stress affects the body. “Thinking about how our cells are responding is often more compelling.”

In a recent interview, Epel talked about her collaboration with Blackburn, a biologist who won a Nobel Prize for her groundbreaking research on telomeres (TEE-luh-meers). Telomeres are tiny protective caps on the ends of our chromosomes that play a key role in aging and disease.

Starting as a post-doctoral researcher at UC San Francisco, Epel worked with Blackburn to investigate how people’s mental states affect their telomeres. After years of research, the two decided to write a book together to share the latest discoveries about telomeres and health with nonscientific readers. The result is The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer.

The response has been gratifying. “We get emails from people who say the book was life-changing for them,” Epel noted. “That makes me feel like it all was worth it.”

KEY TO AGING

Telomeres play a crucial role in shielding our DNA from damage. Each time a cell divides, the telomeres protecting its genetic material shorten. When telomeres get too short, cells die and people age. This process helps bring on many of the diseases linked to aging.

Not everyone ages at the same rate, though. “Why are some people whip smart and energetic into old age, while other people, much younger, are sick, exhausted, and foggy?” the authors ask. A key to this difference lies in the telomeres.

It turns out that psychological stress and certain lifestyle factors take a toll on telomeres, causing them to shorten before their time. But other behaviors can safeguard telomeres, maintaining their length or even allowing them to grow longer.

In The Telomere Effect, Epel and Blackburn sum up what scientists know about the factors that affect telomere length. They hope this information will motivate readers to change their habits. The goal is a longer “healthspan”—the portion of life spent in good health. Many of the book’s chapters end in Renewal Labs, activities aimed at helping readers put the advice into practice.

“What we do today matters not just for today but for all subsequent days,” Epel said. “We have more control over the process of aging than it may seem.”

MIND AND BODY

Epel was drawn to science even as a young child. Her father was a marine biologist and a professor at Stanford University. “We were always spending time by the ocean and being exposed to science,” she said. The family lived in La Jolla and Carmel, California, and spent summers near Woods Hole Oceanographic Institute in Massachusetts.

Epel thought she might become a medical doctor. She started at the Claremont Colleges in Southern California and then switched to Stanford. There, while completing a degree in psychology, she got a chance to try her hand at research.

“That led me to realize how much I loved research,” she said. “I wanted to get more training in that rather than in the practice of medicine.”

As Epel went through school, she became more and more fascinated by the connection between the mind and body. She got a B.A. from Stanford in 1990 and moved on to Yale University, where she earned a PhD in clinical and health psychology in 1998.

TELOMERE TEAM

Epel began postdoctoral studies at UC San Francisco, where Blackburn was a professor in the Department of Microbiology and Immunology. (Blackburn shared the Nobel Prize in medicine in 2009 for co-discovering telomerase, an enzyme that helps restore telomeres. She is now president of the Salk Institute for Biological Studies in La Jolla.)

Epel was interested in exploring what stress does to telomeres. She and another post-doctoral researcher, Jue Lin, began working with Blackburn in 2000. “The three of us worked together for 15 years and did all sorts of studies, as well as collaborating with other scientists,” Epel said.

“We have complementary areas of expertise,” she explained. Blackburn “has done the basic scientific research on how telomerase and telomeres work in single-celled organisms.” Epel brought expertise in how behavioral and psychological stress affect the body. Lin developed sensitive methods that worked on human cells to measure cell aging under different circumstances. She now runs a measurement center at UC San Francisco that supports studies around the world.

Working as part of a group suited Epel. “Team science gives us this ability to work with people who are doing all sorts of studies in animals and humans,” she said. “What one person can do is very little, but when you work in teams, it’s more fun but it’s also better science. We learn more.”

Epel continued her research as she joined the faculty at UC San Francisco and became a professor. She is now director of the university’s Aging, Metabolism, and Emotions Center and associate director of the Center for Health and Community. She is a member of the National Academy of Medicine, and she received an Early Career Award from the American Psychological Association, among other honors.

GETTING IT ALL DOWN ON PAPER

Before getting to work on The Telomere Effect, Epel had other offers to write books about her research on stress. But she wasn’t sure she had something truly new to say.

Then a literary agent, Doug Abrams, heard her give a presentation and suggested a book for general readers about the science of aging in relation to human experiences. That made sense to Epel. “The idea of really being able to describe the interesting science of cell aging and how it affects us in our everyday lives sounded like a worthwhile challenge,” she said.

Epel and Blackburn sat down and worked out a blueprint for the book. Then they spent two years doing the actual writing. “We wrote different sections,” Epel said. “Liz wrote more about the basic biology, and I wrote more about the human behavior and psychology.”

Epel had to get the hang of writing for general readers rather than for other scientists. “It’s very different than scientific writing,” she said. “But I loved the challenge. It makes you really think about what the most important lessons from science are and how to tell them in a way that is logical and meaningful to normal people, and is still accurate. It’s certainly more creative than writing scientific papers.”

BAD STRESS AND GOOD STRESS

In The Telomere Effect, Epel and Blackburn trace various strands of research on how our mental states and lifestyles affect our telomeres. Perhaps the most striking finding is how dramatically psychological stress alters the telomeres.

In their first study together, Epel, Blackburn, and Lin looked at a population under severe stress—mothers caring for chronically ill children. The impact was clear: “The longer a mother had been looking after her sick child, the shorter her telomeres.” That pattern was borne out in other studies.

But it’s not just the amount of stress people experience that matters. It’s how they handle that stress. Those who worry about stressful events beforehand and ruminate about them afterward suffer the most telomere shortening.

People who approach stressful events in a positive way, as challenges to be overcome, fare better. Telomeres “may be stabilized or even lengthened by practicing habits that promote stress resiliency,” the authors write. Among these habits are optimism, mindfulness, and self-compassion.

BEHAVIORS THAT MATTER

The book also looks at the impact of physical activity—or lack of it—on the telomeres. The bottom line is that moderate aerobic exercise on a regular basis helps maintain telomeres.

“Some people say that (this advice) is nothing they haven’t heard,” Epel observed. “But many of us like to understand the mechanisms behind things . . . We understand why we should go to the gym when we don’t feel like it. Plus, our advice is more specific. It tells you what it is about exercise and what it is about sleep that impacts our cell aging.”

What about diet? The research on telomeres supports the recommendations of many nutritionists. “Eat plenty of fruits, vegetables, whole grains, beans, legumes, nuts and seeds, along with low-fat, high-quality sources of protein,” Epel and Blackburn conclude.

Studies also show that adequate sleep boosts the telomeres. That finding led Epel to alter her own behavior. “That’s one of the areas where I needed to change,” she said. “I take sleep more seriously. I do a lot better at prioritizing it now.”

The Telomere Effect also looks at the bigger picture—how the environments we live in affect our telomeres. Research shows people who live in supportive communities and places with lots of greenery tend to have longer telomeres. But people who face racial discrimination or live in places where they feel threatened or isolated suffer damage at the cellular level, in the form of shorter telomeres.

Epel and Blackburn end their book with a call to use what we know about telomeres and health to improve our communities.

“Telomere science offers molecular proof of the importance of societal health to our individual well-being,” they write. “We now have a way to index and measure the interventions we create to improve that health. Let’s get started.”

Will there be a follow-up to The Telomere Effect? Epel isn’t sure yet. “Maybe there will be another book, but not for a while,” she said. “There are too many new research questions to answer!”

See TELOMERE TIPS (below) for a summary of ways to protect telomeres.

Watch a video on Elissa Epel and Elizabeth Blackburn's research.

In The Telomere Effect, Elizabeth Blackburn and Elissa Epel sum up the most crucial steps you can take to protect your telomeres. Here are some highlights:

Stress

Make changes to reduce sources of persistent, intense stress.
Approach stressful events as challenges rather than threats.
Be more compassionate to yourself and to others.
Take up activities that make you feel restored.
Practice thought awareness and mindfulness.

Lifestyle

Be active.
Develop a sleep ritual for better, longer sleep.
Eat mindfully to reduce overeating.
Choose healthful whole foods.
Disconnect from screens for part of the day.
Cultivate a few good, close relationships.
Spend time in nature.

Community

Promote connections within your neighborhood.
Improve prenatal care.
Protect children from violence and other traumas.
Reduce inequality.
Clean up toxic pollutants.
Make fresh, healthy, affordable food available to everyone.